Abdominal Pain and Cramps

On-and-off abdominal pain and cramps are some of the most common symptoms of Crohn’s disease and ulcerative colitis.1,2 Pain and cramping are particularly common symptoms if you have inflammation in the small intestine, which can occur with Crohn’s disease.3,4 However, inflammation anywhere in the digestive tract could cause abdominal pain. You may feel pain around the belly button or on the lower right side of the abdomen.3 It often occurs 1 to 2 hours after eating, but can occur at any time with no obvious cause.3 The pain may be so severe that you eat less—or avoid eating—to prevent pain and cramping.3

For many patients, abdominal pain gets worse when inflammatory bowel disease (IBD) flares up.5 Active inflammation can cause pain. Pain can also be a sign of an obstruction or abscess.3,5 However, people with IBD may have abdominal pain during remission, too. Inflammation can make the nerves more sensitive. It may cause lasting changes that contribute to pain during remission.5

Ongoing abdominal pain can impact your overall well-being.5 Fear of the pain can reduce your quality of life. Abdominal pain has been linked to depression in children and teenagers with IBD.6

What other conditions can cause abdominal pain?

There are dozens of conditions that can cause pain and cramping in the abdomen. Conditions that are sometimes confused with IBD are:7,8

  • Appendicitis
  • Stomach ulcers
  • Stomach irritation (gastritis)
  • Gastroesophageal reflux disease (GERD)

Irritable bowel syndrome is a functional disorder. It causes similar symptoms as inflammatory bowel disease, including pain and cramping. However, irritable bowel syndrome does not damage the intestine the way Crohn’s disease does.

How common is abdominal pain?

An estimated 50% to 70% of adults have abdominal pain when their inflammatory bowel disease flares.5 About 20% have pain even when the disease is in remission.5

How is abdominal pain evaluated?

If your abdominal pain and cramps get worse, it could be a sign that your inflammatory bowel disease is flaring up.9 It may be necessary to see your health care provider. You may need blood or stool tests to check for signs of inflammation. Your provider may want to do procedures such as colonoscopy or upper endoscopy, computed tomography (CT) scan, or small-bowel follow-through. These procedures are done to check for inflammation, obstruction, or abscess.9

How is abdominal pain treated?

If abdominal pain is a sign of a Crohn’s disease or ulcerative colitis flare, the goal is to treat the underlying disease. Pain and cramps should improve within a few weeks of treatment.3 If there is no improvement, you may need further evaluation. Your provider may need to check for complications.

Pain medications can be helpful. Some health care providers recommend acetaminophen or COX-2 inhibitors instead of non-steroidal anti-inflammatory drugs (NSAIDs). In a high-quality study, people were randomly assigned to the COX-2 inhibitor celecoxib or fake treatment (placebo).9 There was no difference in disease flares between the 2 groups. In a different trial, people were less like to have a disease flare with acetaminophen than with an NSAID.9

An estimated 1 in 6 people with inflammatory bowel disease use opioid medications regularly for pain.5 This use of opioids is controversial. Opioids often cause problems with digestive tract function. Additionally, there is a risk of abuse. Nevertheless, it is important for providers to recognize when there is the legitimate need for adequate pain relief.9 Patients who discuss opioid medications with their providers should not be automatically labeled as “drug-seekers.”

Sometimes, the pain is very difficult to control, even with medication. Your health care provider may suggest therapy or antidepressants in order to help you cope with the unrelenting pain.9 Antidepressants have not been well studied in people with inflammatory bowel disease. Therapy may improve anxiety, depression, and coping skills. However, it does not improve Crohn’s disease or ulcerative colitis.

Written by: Sarah O'Brien and Emily Downward | Last Reviewed: January 2018.
View References